As The Hill reported earlier this week, Republicans are barreling toward a vote on health care with the ACA subsidies expiring without a clear plan:

Some Senate Republicans are expressing frustration that their conference hasn’t been able to unify behind a health care plan ahead of a vote next week on a Democratic proposal to extend health insurance premium subsidies that will expire in January.

Republicans are worried the subsidies, and health insurance and costs more broadly, could become a major issue in the 2026 midterms that — in a worst-case scenario — could cost them the Senate majority.

The GOP has no consensus on how to proceed on the issue, which may spur a group of Republican senators to cross the aisle next week and vote for a Democratic bill to extend the subsidies under the Affordable Care Act (ACA).

Republicans say they won’t have their alternative proposal to address rapidly rising insurance premiums ready in time for next week’s vote, leaving some GOP senators dissatisfied about the lack of a clear strategy to counter the Democrats’ bill. [...]

Cassidy has unveiled a proposal to leave the original ACA premium tax credits in place but convert funding for the enhanced premium tax credits into contributions to health savings accounts that Americans could use to pay out-of-pocket health care costs.

As this article from KFF this week laid out, those health savings accounts cover a lot of things, but insurance premiums isn't one of them:

With the tax-free money in a health savings account, a person can pay for eyeglasses or medical exams, as well as a $1,700 baby bassinet or a $300 online parenting workshop.

Those same dollars can’t be used, though, to pay for most baby formulas, toothbrushes — or insurance premiums.

President Donald Trump and some Republicans are pitching the accounts as an alternative to expiring enhanced federal subsidies that have lowered insurance premium payments for most Americans with Affordable Care Act coverage. But legal limits on how HSAs can and can’t be used are prompting doubts that expanding their use would benefit the predominantly low-income people who rely on ACA plans.

The Republican proposals come on the heels of a White House-led change to extend HSA eligibility to more ACA enrollees. One group that would almost certainly benefit: a slew of companies selling expensive wellness items that can be purchased with tax-free dollars from the accounts.

That didn't stop Sen. Bill Cassidy as touting them as a solution to the ACA subsidies expiring on this weekend's Fox News Sunday, where he also expressed concern over insurance company profits while discussing his plan:

BREAM: I was talking with the director there about how involved the White House is or isn't in these health care discussions and negotiations. Can you give us some insight into that, whether the president may be interested in signing off an extension of the ACA subsidies, or what other policy moves the White House might endorse?

CASSIDY: I think the White House and Republicans are very much in favor of Americans having affordable health insurance. They want Americans to have access. And the president's given pretty clear guidelines. He wants money to go to patients and not to insurance companies.

And so the kind of marching orders I've taken from the president is how do we offer our fellow Americans who are on the Obamacare exchanges, and would be paying, in some cases, $33,000 for policies that have been set up by Democrats, an ability for them to have a lower premium and have money go to the patient, not to the insurance company, so they have an account to help pay for their medical expenses.

The president gave the marching orders, we're working on it, want to deliver it.

BREAM: It will take time. Nobody is under the illusion, I think, that with 10 working days or so, maybe less, left for the Senate in this year, that an overhaul of the healthcare system or long-term solutions happen before the end of the year.

So will there be some portion of this that would extend the subsidies? And I know that you are looking at this in the context of money funneling into health savings accounts, but will an extension go on while you try to figure out the policy?

CASSIDY: Shannon, you nailed it. You can't fix everything by January 1, 2026. You nailed it. And so you got to work with what you have. Now, it's a political decision whether or not to continue the subsidies in some extent. But if we did continue those subsidies to a certain extent, you'd either be giving 100 % of the money to the insurance companies, in which they take 20 % of it for deductible and copay, or -- so only 80 % comes back to the patient, 20 % deductible and copay -- or you give 100 % to the patient.

That's what the president wants to do. So if we do continue the subsidies, you can put that over here, 100 % go into the patient, and put it into a health savings account. They get a cheaper premium, and they get first dollar coverage. They have money in their account to pay for their daughter's sprained ankle, off the bat. That's a better thing. Let's give the American people a choice. And you're right, we got to do it by next year. We can do this by next year.

BREAM: Okay, I want to read something from National Review talking about this proposal that would extend some of these subsidies, although in a different way, and whether you can get the votes together for that. From both sides of the aisle, they write this, "Republicans who are open to Cassidy's plan may be hesitant to sign on to any proposal that would keep enhanced Obamacare subsidy funding at current levels. And even if enough GOP senators warm to the plan, winning over enough Democrats to clear the filibuster 60-vote threshold for passing legislation will be tricky." Where are you on bipartisan support for this idea?

CASSIDY: So I've been talking to Democrats. There's absolute interest. I'd like to say that some of them, you know, no American wants a fellow American to not to be able to afford health insurance. Now, we may disagree the threshold. The original Obamacare put the limit of a percentage of your income, I think at like 9.8 % or something like that. So we may argue about that, but if we can get to a framework where they give the American people a choice, they can stay with the policy they have with a $6,000 deductible, or then go to another policy with a lower premium and money in a health savings account for them to purchase that which they do.

The rest is just political decisions. What dial do you turn here, dial you turn there in order to get your votes? I think we can do this if people have a good will. I say we don't want a Republican solution, a Democratic solution, we want an American solution that works for Americans. If my Democratic friends believe that, we can do it.

He later added this in response to Chuck Schumer telling Republicans they had a week to decide whether to extend the subsidies or not:

CASSIDY: As always, Chuck is wrong. The choice he has given is a false choice. The choice he wants to give the American people is a $6,000 deductible, a system which we send $26 billion to insurance companies, and they take 20 % of it for profit and overhead. No, give them that choice. OK, you want a policy with a $6,000 deductible, you got it. We want to give an additional choice, one in which your premium is lower and that you have money and an account to help pay for it.

If he wants to give people that choice, I'm okay with that. But let's give them a side-by-side choice, both on the exchanges. The patient makes the decision, not Chuck Schumer. Let the patient make the decision. That's the way it should be. Let the American have the power. Let the patient have the power.

If Cassidy wants to give them a "choice" that doesn't involve the insurance industry taking their cut, he'd be in favor of Medicare for All, or at minimum a public option where people can buy into Medicare, but you'll never hear him or any other Republican saying they're in favor of that.

They love to pretend they don't favor the insurance companies or protecting their profits, but their actions say otherwise. The rest is just lip service.

Ed. Note (Karoli): It should go without saying, but $33,000 into a health savings account won't even cover a 2 day hospital stay, much less the expenses for doctors, medications and whatever else they charge for. This is a ridiculous and unserious idea.